Provider Demographics
NPI:1518088665
Name:MAKI, TAKASHI (MD)
Entity Type:Individual
Prefix:
First Name:TAKASHI
Middle Name:
Last Name:MAKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 CENTER STREET
Mailing Address - Street 2:P.O. BOX 236
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030
Mailing Address - Country:US
Mailing Address - Phone:617-667-0896
Mailing Address - Fax:
Practice Address - Street 1:HARVARD INST OF MEDICINE
Practice Address - Street 2:77 AVENUE LOUIS PASTEUR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-667-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45437208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice